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Blockade of the Growth Hormone (GH) Receptor Unmasks Rapid GH-Releasing Peptide-6-Mediated Tissue-Specific Insulin Resistance

Department of Internal Medicine, Erasmus Medical Center Rotterdam (A.F.M., J.A.J., L.J.H., S.W.L., A.J.v.d.L.), 3015 Rotterdam, The Netherlands; and Department of Internal Medicine, Medical Klinik Innenstadt, Ludwig-Maximillians University (M.B., C.J.S.), 80336 Munich, Germany

Address all correspondence and requests for reprints to: A. J. van der Lely, M.D., Department of Internal Medicine, 40 Dr. Molewaterplein, 3015 GD Rotterdam, The Netherlands. E-mail: vanderlely{at}inw3.azr.nl

The roles of GH and its receptor (GHR) in metabolic control are not yet fully understood. We studied the roles of GH and the GHR using the GHR antagonist pegvisomant for metabolic control of healthy nonobese men in fasting and nonfasting conditions. Ten healthy subjects were enrolled in a double blind, placebo-controlled study on the effects of pegvisomant on GHRH and GH-releasing peptide-6 (GHRP-6)-induced GH secretion before and after 3 days of fasting and under nonfasting conditions (n = 5). Under the condition of GHR blockade by pegvisomant in the nonfasting state, GHRP-6 (1 µg/kg) caused a increase in serum insulin (10.3 ± 2.1 vs. 81.3 ± 25.4 mU/L; P < 0.001) and glucose (4.2 ± 0.3 vs. 6.0 ± 0.6 mmol/L; P < 0.05) concentrations. In this group, a rapid decrease in serum free fatty acids levels was also observed. These changes were not observed under GHR blockade during fasting or in the absence of pegvisomant. We conclude that although these results were obtained from an acute study, and long-term administration of pegvisomant could render different results, blockade of the GHR in the nonfasting state induces tissue-specific changes in insulin sensitivity, resulting in an increase in glucose and insulin levels (indicating insulin resistance of liver/muscle), but probably also in an increase in lipogenesis (indicating normal insulin sensitivity of adipose tissue). These GHRP-6-mediated changes indicate that low GH bioactivity on the tissue level can induce changes in metabolic control, which are characterized by an increase in fat mass and a decrease in lean body mass. As a mechanism of these GHRP-6-mediated metabolic changes in the nonfasting state, direct nonpituitary-mediated GHRP-6 effects on the gastroentero-hepatic axis seem probable.

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